Changes

It occurred to me that some patients will experience anxiety when a change occurs in their mode of therapy. For example, a relatively new patient (3 or so months into therapy) has struggled with [[Fixed CPAP | fixed ]] or [[Auto-CPAP | auto CPAP ]] and has recently begun therapy using a [[Bilevel positive airway pressure (BPAP) | bilevel CPAP ]] machine, and the new therapy has been like a brand new obstacle to overcome.

Without diminishing the very real challenge of [[Continuous_positive_airway_pressure_(CPAP ) | CPAP]] therapy and how serious the anxiety can be, I wonder if I can throw some words down here in an attempt to alleviate, possibly, some of the anxiety and frustration associated with the change in modes and/or beginning of therapy, whether it be from fixed or auto CPAP to bilevel CPAP or even to advanced bilevel CPAP such as [[Bilevel positive airway pressure (BPAP) | spontaneous/timed (S/T) ]] machines and [[Adaptive servo-ventilation (ASV) | adaptive servo ventilator machines (ASV)]].

Some very well written posts with explanations about nomenclature and all of the abbreviations [[Acronyms | (cpap, vpap, bpap, asv, xpap…) ]] exist on the forum and my worry for new folks and those transitioning to new modes of therapy is that there may be some mystique and rightfully acquired confusion about all the different ways to obtain the same results. Afterall, we are on the same path to the same goal; a good night's rest night after night.

So, in the beginning, we had single pressure (fixed ) CPAP therapy that delivers a single pressure all night long. Often referred to as just CPAP. A breakthrough for people suffering from inconsistent and broken breathing while they slept [[Sleep_apnea | (apnea)]]. These machines are used when a patient experiences [[Obstructive sleep apnea (OSA) | obstructive apnea ]] and do not exhibit signs of [[Central sleep apnea (CSA) | central apnea]], [[Periodic breathing | periodic breathing]], or [[Complex sleep apnea | complex apnea ]] (a mixture of every apnea).

Often times, and for various reasons, a single pressure is not the best means of therapy. A machine that delivers two different pressures is required for patient comfort or the enhanced ventilation of a patient. Bilevel CPAP therapy delivers two distinct pressures. One pressure for inhalation and a lower pressure for exhalation. The machine is called BiPAP (Philips-Respironics) or VPAP (Resmed), xPAP and BPAP. These terms are used interchangeably to describe bilevel (two pressure) CPAP therapy. It is arguable about that Resmed auto CPAP machines that use expiratory pressure relief (EPR), that they, in fact, are bilevel CPAP machines, because [[Expiratory Pressure Relief (EPR) | EPR ]] uses two distinct pressures for inhale and exhale up to 3 [[CmH2O | cmH2O ]] of pressure difference. For the purposes of this writing, I should note that the term bilevel applies to the machines that can deliver >3 cmH2O pressure differences between inhale and exhale pressures. A bilevel machine is still a CPAP machine, as it delivers a continuous pressure to the airway to prevent apnea. CPAP is continuous positive airway pressure. Bilevel CPAP is used to treat obstructive apnea and [[Hypopnea | hypopnea]]. These machines are helpful for people with other pulmonary conditions such as [[Chronic obstructive pulmonary disease (COPD) |COPD ]] because of the difference in inhale and exhale pressure (pressure support) is useful used to alleviate respiratory effort.

The capabilities of bilevel CPAP are further enhanced with advanced bilevel CPAP machines. These machines are referred to as bilevel S/T, BiPAP S/T, VPAP S/T, ASV, autoSV or bilevel with a backup rate. These high tech devices are for patients who experience unresolved central apnea or periodic breathing that requires the machine to initiate a breath when the patient will not on their own (spontaneously) or to stabilize breathing patterns into a uniform and natural flow of inhalation and exhalation. Specifically, the advanced bilevel CPAP machines will raise pressure to coax a patient into breathing and help to deliver a volume of air on a timed basis, whereas a patient may go for a period of time without breathing and without obstruction (central apnea). By the way, central apnea gets its name stemming from the central nervous system (brain and periphery) versus obstructive apnea which occurs via a physical blockage of the airway (relaxation of the muscle associated with keeping the airway open in a lot of cases).

In summary, these machines in all their various forms and types and behaviors are basically CPAP machines. In all the hype that may be perceived about one machine type or mode, we are still getting CPAP therapy in one way or the other. Although all the machines will feel different in pressure and behavior, and some take more getting used to, its still CPAP therapy.For fresh eyes on the matter of CPAP therapy, there is a lot to learn, and for long time users, there is much more to learn. All the information can be very overwhelming and difficult to follow but getting down to the basics, it’s all just CPAP therapy.